Hypertension is defined as sustained elevation of systemic arterial pressure beyond 140/90 mmHg in an adult. It is usually a chronic medical condition, which leads to damage the blood vessels of various organs including brain, heart, kidney, eye etc. Management of a hypertensive individual includes maintenance of optimal blood pressure as well as routine screening and attending to its secondary adverse effects on organs.
Hypertension is graded as following according to its severity
| Category | Systolic (mmHg) | Diastolic(mmHg) |
| Normal | <120 | <80 |
| Pre-hypertension | 120-139 | 80-89 |
| Grade 1 hypertension | 140-159 | 90-99 |
| Grade 2 hypertension | 160-179 | 100-110 |
| Grade 3 hypertension | >180 | >110 |
| Isolated systolic hypertension | >140 | >90 |
Hypertension can be broadly classified in to two groups,
• Primary (essential) – hypertension without underlying identifiable cause. 90- 95% of all hypertensive individuals belong to this category.
• Secondary – hypertension arises due to an underlying medical condition (e.g. kidney disease, SLE, blood vessel diseases etc.). 5-10% of hypertensives belong to this category.
Though hypertension runs a chronic cause in majority; sometimes blood pressure goes out of control, rapidly rising over 180/120mmHg within a short time. This is called a hypertensive crisis. Unlike chronically elevated blood pressure this accelerated phase rapidly damages the blood vessels all over the body affecting many systems and bringing about severe consequences.
Causes of hypertensive crisis–
• Missing doses of blood pressure medication
• Stroke
• Renal failure
• Heart failure
• Pre – eclampsia and eclampsia in pregnant.
Signs and symptoms of hypertensive crisis-
• Most of the time asymptomatic
• Lightheadedness
• Vertigo and dizziness
• Severe headache
• Severe chest pain
• Shortness of breathing
• Nausea and vomiting
• Tinnitus
• Fainting episodes
• Seizures
• Severe anxiety
• Loss of consciousness
• Other symptoms related to secondary condition.
These symptoms are non – specific and rarely indicate hypertension as a cause. But first aid training courses should emphasize the value of measuring blood pressure in individuals claim to have these symptoms. Simple handheld electronic blood pressure monitors can be used for this task at community level.
Before measurement of blood pressure patient should rest for 20 minutes. Patient should be seated or lying down with correct sized blood pressure cuff applied to upper arm at the level of heart.
Consequences of hypertensive crisis-
• Heart attack
• Heart failure
• Kidney damage/failure
• Transient ischemic attack
• Stroke – due to rupture of brain aneurysms.
• Progressive vision loss
• Pulmonary edema – fluid buildup on lungs
• Convulsions
• Loss of consciousness
The primary modality of hypertensive crisis treatment is aggressive intravenous anti – hypertensive medication in order to bring blood pressure down. This is carried out in hospital following referral to urgent medical attention in these patients.
Still there is some place in first aid measures that can be used to prevent/manage these complications while waiting for medical help to arrive; increasing the chances of the patient to make a complete recovery without any morbidity.
First aid management-
1. Reassure the patient and call for medical help.
2. Make him/her to lie on the bed and rest adequately.
3. Try to comfort and reduce anxiety, as anxiety alone can increase blood pressure.
4. Keep monitoring breathing, pulse rate, blood pressure, level of consciousness and for any other dangerous signs ( e.g. paralysis of body in stroke, convulsions etc.)
5. Do not allow them to walk about, accompany the patient if it is really needed. Watch out for falls.
6. If the patient is vomiting or having seizures, turn to lateral side to prevent aspiration.
7. If patient complains of difficulty in breathing, prop him/her up using pillows behind upper back.
8. Do not give anything by mouth to eat/drink if there is suspicion of stroke.
9. Specially avoid caffeine or alcohol containing beverages.
10. Meanwhile look for possible cause for hypertensive crisis. If the patient is a known hypertensive and missed medication, consult doctor over the phone and give a dose of medications if instructed.
11. If breathing is unsatisfactory go for basic life support. Mouth to mouth breathing and CPR if needed.
Online Sources
http://www.mayoclinic.com/health/hypertensive-crisis/AN00626
My grand mother age 92y she is fine just normal problam of bp ,,, and last 2 months 2 high bp attack first attack she has save
but not speaking then 2nd attack affect totaly body not movment just breathing continue so plz tell me what can we do
Hi Gurpreet,
Sorry to hear. You definitely need to discuss this with your Grand mother’s doctor as soon as possible.